Provider First Line Business Practice Location Address:
5120 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-448-7853
Provider Business Practice Location Address Fax Number:
502-448-2281
Provider Enumeration Date:
05/23/2005